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The ECG in acute myocardial infarction

Select the Essentials tab to view an ECG from a 57-year-old man. He has had indigestion-like chest pain for the past hour and feels very sweaty and unwell. Which of the following statements is correct?
Select two or more options and then select Confirm.
A question mark.
This is an anterior wall STEMI
 
There is a bradycardia
 
Q waves are present in the anterior leads
 
Treatment including morphine is appropriate
 
Immediate reperfusion therapy is indicated
 
None of these statements is correct
 

That is not quite right.

That is still not quite right. All these statements were true. ST segment elevation is present in leads V1-V4 so this is an anterior infarct. The rhythm is a regular narrow-complex bradycardia with a P wave before each QRS complex, indicating sinus bradycardia. Small but definite Q waves are present in the anterior leads. In a patient experiencing continuing pain from acute MI, an analgesic such as morphine is an important part of the immediate treatment, and as this is ST-segment-elevation MI immediate arrangements for reperfusion therapy are also indicated.

That is not right.

That is still not right. All these statements were true. ST segment elevation is present in leads V1-V4 so this is an anterior infarct. The rhythm is a regular narrow-complex bradycardia with a P wave before each QRS complex, indicating sinus bradycardia. Small but definite Q waves are present in the anterior leads. In a patient experiencing continuing pain from acute MI, an analgesic such as morphine is an important part of the immediate treatment, and as this is ST-segment-elevation MI immediate arrangements for reperfusion therapy are also indicated.

That is right. All these statements were true. ST segment elevation is present in leads V1-V4 so this is an anterior infarct. The rhythm is a regular narrow-complex bradycardia with a P wave before each QRS complex, indicating sinus bradycardia. Small but definite Q waves are present in the anterior leads. In a patient experiencing continuing pain from acute MI, an analgesic such as morphine is an important part of the immediate treatment, and as this is ST-segment-elevation MI immediate arrangements for reperfusion therapy are also indicated.

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See chapter 8 of the ALS manual for further explanation and examples about how to analyse ECG rhythm strips.

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ECG from a 57-year-old man.
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<p>Components of a normal ECG – close up of a rhythm strip.</p><p></p>

The 6-stage approach

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1. Is there any electrical activity?

2. What is the ventricular (QRS) rate?

3. Is the QRS rhythm regular or irregular?

4. Is the QRS width normal (narrow) or broad?


Any cardiac rhythm can be described accurately and managed safely and effectively using the first four steps.


5. Is atrial activity present? (If so, what is it: Typical sinus P waves? Atrial fibrillation? Atrial flutter? Abnormal P waves?)

6. How is atrial activity related to ventricular activity? (e.g 1:1 conduction, 2:1 conduction, etc, or no relationship)

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